tbuckley/cabot-search huggingface dataset:
Effect of Extending the Duration of Prequit Treatment With Varenicline on Smoking Abstinence
Authors: Larry W. Hawk, Stephen T. Tiffany, Craig R. Colder, Rebecca L. Ashare, Jennifer M. Wray, Rachel F. Tyndale, Thomas H. Brandon, Martin C. Mahoney
Journal: JAMA Network Open (2022)

Importance Even with varenicline, the leading monotherapy for tobacco dependence, smoking abstinence rates remain low. Preliminary evidence suggests that extending the duration of varenicline treatment before quitting may increase abstinence. Objective To test the hypotheses that, compared with standard run-in varenicline treatment (1 week before quitting), extended run-in varenicline treatment (4 weeks before quitting) reduces smoking exposure before the target quit date (TQD) and enhances abstinence, particularly among women. Design, Setting, and Participants This double-blind, randomized, placebo-controlled clinical trial enrolled participants from October 2, 2017, to December 9, 2020, at a single-site research clinic in Buffalo, New York. Of 1385 people screened, 320 adults reporting smoking 5 or more cigarettes per day (CPD) were randomized and followed up for 28 weeks. Data were analyzed from August 2021 to June 2022. Interventions In the pre-TQD period (weeks 1-4), the extended run-in group received 4 weeks of varenicline; the standard run-in group received 3 weeks of placebo followed by 1 week of varenicline. Both groups received open-label varenicline during weeks 5 to 15 and brief quit counseling at 6 clinic visits. Main Outcomes and Measures The primary outcome consisted of cotinine-verified (at end of treatment [EOT]) self-reported continuous abstinence from smoking (in CPD) during the last 4 weeks of treatment. Secondary outcomes included bioverified self-report of continuous abstinence at the 6-month follow-up and percentage of reduction in self-reported smoking rate during the prequit period (week 1 vs week 4). Results A total of 320 participants were randomized, including 179 women (55.9%) and 141 men (44.1%), with a mean (SD) age of 53.7 (10.1) years. Continuous abstinence during the final 4 weeks of treatment (weeks 12-15; EOT) was not greater in the extended run-in group (64 of 163 [39.3%]) compared with the standard run-in group (57 of 157 [36.3%]; odds ratio [OR], 1.13 [95% CI, 0.72-1.78]), nor was the hypothesized group × sex interaction significant (OR, 0.52 [95% CI, 0.21-1.28]). Similar nonsignificant results were obtained for continuous abstinence at the 6-month follow-up. The mean (SE) decrease in self-reported smoking rate during the prequit period was greater in the extended run-in group (−38.8% [2.8%]) compared with the standard run-in group (−17.5% [2.7%]). Conclusions and Relevance Among adult daily smokers, extending the duration of prequit varenicline treatment beyond the standard 1-week run-in period reduced prequit smoking exposure but, more importantly, did not significantly improve continuous abstinence rates. Trial Registration ClinicalTrials.gov Identifier: NCT03262662
Patterns in Geographic Distribution of Substance Use Disorder Treatment Facilities in the US and Accepted Forms of Payment From 2010 to 2021
Authors: Jonathan H. Cantor, Maria DeYoreo, Russell Hanson, Aaron Kofner, David Kravitz, Adrian Salas, Bradley D. Stein, Kandice A. Kapinos
Journal: JAMA Network Open (2022)

Importance The drug overdose crisis is a continuing public health problem and is expected to grow substantially in older adults. Understanding the geographic accessibility to a substance use disorder (SUD) treatment facility that accepts Medicare can inform efforts to address this crisis in older adults. Objective To assess whether geographic accessibility of services was limited for older adults despite the increasing need for SUD and opioid use disorder treatments in this population. Design, Setting, and Participants This longitudinal cross-sectional study obtained data on all licensed SUD treatment facilities for all US counties and Census tracts listed in the National Directory of Drug and Alcohol Abuse Treatment Programs from 2010 to 2021. Main Outcomes and Measures Measures included the national proportion of treatment facilities accepting Medicare, Medicaid, private insurance, or cash as a form of payment; the proportion of counties with a treatment facility accepting each form of payment; and the proportion of the national population with Medicare, Medicaid, private insurance, or cash payment residing within a 15-, 30-, or 60-minute driving time from an SUD treatment facility accepting their form of payment in 2021. Results A total of 11 709 SUD treatment facilities operated across the US per year between 2010 and 2021 (140 507 facility-year observations). Cash was the most commonly accepted form of payment (increasing slightly from 91.0% in 2010 to 91.6% by 2021), followed by private insurance (increasing from 63.5% to 75.3%), Medicaid (increasing from 54.0% to 71.8%), and Medicare (increasing from 32.1% to 41.9%). The proportion of counties with a treatment facility that accepted Medicare as a form of payment also increased over the same study period from 41.2% to 53.8%, whereas the proportion of counties with a facility that accepted Medicaid as a form of payment increased from 53.5% to 67.1%. The proportion of Medicare beneficiaries with a treatment facility that accepted Medicare as a form of payment within a 15-minute driving time increased from 53.3% to 57.0%. The proportion of individuals with a treatment facility within a 15-minute driving time that accepted their respective form of payment was 73.2% for those with Medicaid, 69.8% for those with private insurance, and 71.4% for those with cash payment in 2021. Conclusions and Relevance Results of this study suggest that Medicare beneficiaries have less geographic accessibility to SUD treatment facilities given that acceptance of Medicare is low compared with other forms of payment. Policy makers need to consider increasing reimbursement rates and using additional incentives to encourage the acceptance of Medicare.
Self-reported Use of Prescribed Buprenorphine Among US Adults With Nonmedical Use of Prescription Opioids Motivated by Pain
Authors: Michele J. Buonora, Minhee L. Sung, Caroline G. Falker, Anne C. Black, William C. Becker
Journal: JAMA Network Open (2022)

This cross-sectional study of US adults examines the prevalence of and characteristics associated with prescribed buprenorphine use among US adults with pain-motivated nonmedical use of prescription opioids.
Development and Validation of an Integrated Suite of Prediction Models for All-Cause 30-Day Readmissions of Children and Adolescents Aged 0 to 18 Years
Authors: Denise M. Goodman, Mia T. Casale, Karen Rychlik, Michael S. Carroll, Katherine A. Auger, Tracie L. Smith, Jenifer Cartland, Matthew M. Davis
Journal: JAMA Network Open (2022)

Readmission is often considered a hospital quality measure, yet no validated risk prediction models exist for children.To develop and validate a tool identifying patients before hospital discharge who are at risk for subsequent readmission, applicable to all ages.This population-based prognostic analysis used electronic health record-derived data from a freestanding children's hospital from January 1, 2016, to December 31, 2019. All-cause 30-day readmission was modeled using 3 years of discharge data. Data were analyzed from June 1 to November 30, 2021.Three models were derived as a complementary suite to include (1) children 6 months or older with 1 or more prior hospitalizations within the last 6 months (recent admission model [RAM]), (2) children 6 months or older with no prior hospitalizations in the last 6 months (new admission model [NAM]), and (3) children younger than 6 months (young infant model [YIM]). Generalized mixed linear models were used for all analyses. Models were validated using an additional year of discharges.The derivation set contained 29 988 patients with 48 019 hospitalizations; 50.1% of these admissions were for children younger than 5 years and 54.7% were boys. In the derivation set, 4878 of 13 490 admissions (36.2%) in the RAM cohort, 2044 of 27 531 (7.4%) in the NAM cohort, and 855 of 6998 (12.2%) in the YIM cohort were followed within 30 days by a readmission. In the RAM cohort, prior utilization, current or prior procedures indicative of severity of illness (transfusion, ventilation, or central venous catheter), commercial insurance, and prolonged length of stay (LOS) were associated with readmission. In the NAM cohort, procedures, prolonged LOS, and emergency department visit in the past 6 months were associated with readmission. In the YIM cohort, LOS, prior visits, and critical procedures were associated with readmission. The area under the receiver operating characteristics curve was 83.1 (95% CI, 82.4-83.8) for the RAM cohort, 76.1 (95% CI, 75.0-77.2) for the NAM cohort, and 80.3 (95% CI, 78.8-81.9) for the YIM cohort.In this prognostic study, the suite of 3 prediction models had acceptable to excellent discrimination for children. These models may allow future improvements in tailored discharge preparedness to prevent high-risk readmissions.
Comparison of Acupuncture vs Sham Acupuncture or Waiting List Control in the Treatment of Aromatase Inhibitor–Related Joint Pain
Authors: Dawn L. Hershman, Joseph M. Unger, Heather Greenlee, Jillian Capodice, Danika L. Lew, Amy Darke, Lori M. Minasian, Michael J. Fisch, N. Lynn Henry, Katherine D. Crew
Journal: JAMA Network Open (2022)

Importance Aromatase inhibitors (AIs) have proven efficacy for the treatment of hormone-sensitive breast cancer; however, arthralgias (pain and stiffness) contribute to nonadherence with therapy for more than 50% of patients. Objective To examine the effect of acupuncture in reducing AI-related joint pain through 52 weeks. Design, Setting, and Participants A randomized clinical trial was conducted at 11 sites in the US from May 1, 2012, to February 29, 2016, with a scheduled final date of follow-up of September 5, 2017, to compare true acupuncture (TA) with sham acupuncture (SA) or waiting list control (WC). Women with early-stage breast cancer were eligible if they were taking an AI and scored 3 or higher on the Brief Pain Inventory Worst Pain (BPI-WP) item (score range, 0-10; higher scores indicate greater pain). Analysis was conducted for data received through May 3, 2021. Interventions Participants were randomized 2:1:1 to the TA (n = 110), SA (n = 59), or WC (n = 57) group. The TA and SA protocols were composed of 6 weeks of intervention at 2 sessions per week (12 sessions overall), followed by 6 additional weeks of intervention with 1 session per week. Participants randomized to WC received no intervention. All participants were offered 10 acupuncture sessions to be used between weeks 24 and 52. Main Outcomes and Measures In this long-term evaluation, the primary end point was the 52-week BPI-WP score, compared by study group using linear regression, adjusted for baseline pain and stratification factors. Results Among 226 randomized women (mean [SD] age, 60.7 [8.6] years; 87.7% White; mean [SD] baseline BPI-WP score, 6.7 [1.5]), 191 (84.5%) completed the trial. In a linear regression, 52-week mean BPI-WP scores were 1.08 (95% CI, 0.24-1.91) points lower in the TA compared with the SA group ( P = .01) and were 0.99 (95% CI, 0.12-1.86) points lower in the TA compared with the WC group ( P = .03). In addition, 52-week BPI pain interference scores were statistically significantly lower in the TA compared with the SA group (difference, 0.58; 95% CI, 0.00-1.16; P = .05). Between 24 and 52 weeks, 12 (13.2%) of TA, 6 (11.3%) of SA, and 5 (10.6%) of WC patients reported receipt of acupuncture. Conclusions and Relevance In this randomized clinical trial, women with AI-related joint pain receiving 12 weeks of TA had reduced pain at 52 weeks compared with controls, suggesting long-term benefits of this therapy. Trial Registration ClinicalTrials.gov Identifier: NCT01535066
Exploration of Residual Confounding in Analyses of Associations of Metformin Use and Outcomes in Adults With Type 2 Diabetes
Authors: Mike Powell, Callahan Clark, Anton Alyakin, Joshua T. Vogelstein, Brian Hart
Journal: JAMA Network Open (2022)

Importance Metformin is often used as a first-line therapy for type 2 diabetes; however, frequent discontinuation with reduced kidney function and increased disease severity indicates that a comparison with any other group (eg, nonusers or insulin users) must address significant residual confounding concerns. Objectives To examine the potential for residual confounding in a commonly used observational study design applied to metformin and to propose a more robust study design for future observational studies of metformin. Design, Setting, and Participants This retrospective cohort study with a prevalent user design was conducted using an administrative claims database for Medicare Advantage beneficiaries in the US. Participants were categorized into 2 distinct cohorts: 404 458 individuals with type 2 diabetes and 81 791 individuals with prediabetes. Clinical history was observed in 2018, and end points were observed in 2019. Statistical analyses were conducted between May and December 2021. Exposures Prevalent use (recent prescription and history of use on at least 90 of the preceding 365 days) of metformin or insulin but not both at the start of the observation period. Main Outcomes and Measures Total inpatient admission days in 2019 and total medical spending (excluding prescription drugs) in 2019. Each of these measures was treated as a binary outcome (0 vs &amp;amp;gt;0 inpatient days and top 10% vs bottom 90% of medical spending). Results The study included 404 458 adults with type 2 diabetes (mean [SD] age, 74.5 [7.5] years; 52.7% female). A strong metformin effect estimate was associated with reduced inpatient admissions (odds ratio, 0.60; 95% CI, 0.58-0.62) and reduced medical expenditures (odds ratio, 0.57; 95% CI, 0.55-0.60). However, implementation of additional robust design features (negative control outcomes and a complementary cohort) revealed that the estimated beneficial effect was attributable to residual confounding associated with individuals’ overall health, not metformin itself. Conclusions and Relevance These findings suggest that common observational study designs for studies of metformin in a type 2 diabetes population are at risk for consequential residual confounding. By performing 2 additional validation checks, the study design proposed here exposes residual confounding that nullifies the initially favorable claim derived from a common study design.
Association of Noncontrast Computed Tomography and Perfusion Modalities With Outcomes in Patients Undergoing Late-Window Stroke Thrombectomy
Authors: Guilherme B. F. Porto, Ching-Jen Chen, Sami Al Kasab, Muhammed Amir Essibayi, Eyad Almallouhi, Zachary Hubbard, Reda Chalhoub, Ali Alawieh, Ilko Maier, Marios-Nikos Psychogios, Stacey Q. Wolfe, Pascal Jabbour, Ansaar Rai, Robert M. Starke, Amir Shaban, Adam Arthur, Joon-Tae Kim, Shinichi Yoshimura, Jonathan Grossberg, Peter Kan, Isabel Fragata, Adam Polifka, Joshua Osbun, Justin Mascitelli, Michael R. Levitt, Richard Williamson, Daniele G. Romano, Roberto Crosa, Benjamin Gory, Maxim Mokin, Kaustubh S. Limaye, Walter Casagrande, Mark Moss, Ramesh Grandhi, Albert Yoo, Alejandro M. Spiotta, Min S. Park
Journal: JAMA Network Open (2022)

There is substantial controversy with regards to the adequacy and use of noncontrast head computed tomography (NCCT) for late-window acute ischemic stroke in selecting candidates for mechanical thrombectomy.To assess clinical outcomes of patients with acute ischemic stroke presenting in the late window who underwent mechanical thrombectomy stratified by NCCT admission in comparison with selection by CT perfusion (CTP) and diffusion-weighted imaging (DWI).In this multicenter retrospective cohort study, prospectively maintained Stroke Thrombectomy and Aneurysm (STAR) database was used by selecting patients within the late window of acute ischemic stroke and emergent large vessel occlusion from 2013 to 2021. Patients were selected by NCCT, CTP, and DWI. Admission Alberta Stroke Program Early CT Score (ASPECTS) as well as confounding variables were adjusted. Follow-up duration was 90 days. Data were analyzed from November 2021 to March 2022.Selection by NCCT, CTP, or DWI.Primary outcome was functional independence (modified Rankin scale 0-2) at 90 days.Among 3356 patients, 733 underwent late-window mechanical thrombectomy. The median (IQR) age was 69 (58-80) years, 392 (53.5%) were female, and 449 (65.1%) were White. A total of 419 were selected with NCCT, 280 with CTP, and 34 with DWI. Mean (IQR) admission ASPECTS were comparable among groups (NCCT, 8 [7-9]; CTP, 8 [7-9]; DWI 8, [7-9]; P = .37). There was no difference in the 90-day rate of functional independence (aOR, 1.00; 95% CI, 0.59-1.71; P = .99) after adjusting for confounders. Symptomatic intracerebral hemorrhage (NCCT, 34 [8.6%]; CTP, 37 [13.5%]; DWI, 3 [9.1%]; P = .12) and mortality (NCCT, 78 [27.4%]; CTP, 38 [21.1%]; DWI, 7 [29.2%]; P = .29) were similar among groups.In this cohort study, comparable outcomes were observed in patients in the late window irrespective of neuroimaging selection criteria. Admission NCCT scan may triage emergent large vessel occlusion in the late window.
Incident Cancer Detection During Multiple Waves of COVID-19: The Tsunami After the Earthquake
Authors: Rui Fu, Rinku Sutradhar, Qing Li, Timothy P. Hanna, Kelvin K.W. Chan, Jonathan C. Irish, Natalie Coburn, Julie Hallet, Anna Dare, Simron Singh, Ambica Parmar, Craig C. Earle, Lauren Lapointe-Shaw, Monika K. Krzyzanowska, Antonio Finelli, Alexander V. Louie, Nicole J. Look Hong, Ian J. Witterick, Alyson Mahar, David Gomez, Daniel I. McIsaac, Danny Enepekides, David R. Urbach, Antoine Eskander
Journal: Journal of the National Comprehensive Cancer Network (2022)

No population-based study exists to demonstrate the full-spectrum impact of COVID-19 on hindering incident cancer detection in a large cancer system. Building upon our previous publication in JNCCN , we conducted an updated analysis using 12 months of new data accrued in the pandemic era (extending the study period from September 26, 2020, to October 2, 2021) to demonstrate how multiple COVID-19 waves affected the weekly cancer incidence volume in Ontario, Canada, and if we have fully cleared the backlog at the end of each wave.
The association between multimorbidity and mobility disability-free life expectancy in adults aged 85 years and over: A modelling study in the Newcastle 85+ cohort
Authors: Laurie E. Davies, Stewart W. Mercer, Katie Brittain, Carol Jagger, Louise Robinson, Andrew Kingston
Journal: PLoS Medicine (2022)

Background Mobility disability is predictive of further functional decline and can itself compromise older people’s capacity (and preference) to live independently. The world’s population is also ageing, and multimorbidity is the norm in those aged ≥85. What is unclear in this age group, is the influence of multimorbidity on (a) transitions in mobility disability and (b) mobility disability-free life expectancy (mobDFLE). Methods and findings Using multistate modelling in an inception cohort of 714 85-year-olds followed over a 10-year period (aged 85 in 2006 to 95 in 2016), we investigated the association between increasing numbers of long-term conditions and (1) mobility disability incidence, (2) recovery from mobility disability and (3) death, and then explored how this shaped the remaining life expectancy free from mobility disability at age 85. Models were adjusted for age, sex, disease group count, BMI and education. We defined mobility disability based on participants’ self-reported ability to get around the house, go up and down stairs/steps, and walk at least 400 yards; participants were defined as having mobility disability if, for one or more these activities, they had any difficulty with them or could not perform them. Data were drawn from the Newcastle 85+ Study: a longitudinal population-based cohort study that recruited community-dwelling and institutionalised individuals from Newcastle upon Tyne and North Tyneside general practices. We observed that each additional disease was associated with a 16% increased risk of incident mobility disability (hazard ratio (HR) 1.16, 95% confidence interval (CI): 1.07 to 1.25, p &lt; 0.001), a 26% decrease in the chance of recovery from this state (HR 0.74, 95% CI: 0.63 to 0.86, p &lt; 0.001), and a 12% increased risk of death with mobility disability (HR: 1.12, 95% CI: 1.07- to .17, p &lt; 0.001). This translated to reductions in mobDFLE with increasing numbers of long-term conditions. However, residual and unmeasured confounding cannot be excluded from these analyses, and there may have been unobserved transitions to/from mobility disability between interviews and prior to death. Conclusions We suggest 2 implications from this work. (1) Our findings support calls for a greater focus on the prevention of multimorbidity as populations age. (2) As more time spent with mobility disability could potentially lead to greater care needs, maintaining independence with increasing age should also be a key focus for health/social care and reablement services.
Genome-wide association meta-analysis of knee and hip osteoarthritis uncovers genetic differences between patients treated with joint replacement and patients without joint replacement
Authors: Cecilie Henkel, Unnur Styrkársdóttir, Gudmar Thorleifsson, Lilja Stefánsdóttir, Gyda Björnsdóttir, Karina Banasik, Søren Brunak, Christian Erikstrup, Khoa Manh Dinh, Thomas Folkmann Hansen, Kaspar René Nielsen, Mie Topholm Bruun, Joseph Dowsett, Thorsten Brodersen, Thorgeir E Thorgeirsson, Kirill Gromov, Mikael Ploug Boesen, Henrik Ullum, Sisse Rye Ostrowski, Ole Birger Pedersen, Kári Stefánsson, Anders Troelsen
Journal: Annals of the Rheumatic Diseases (2022)

Objectives Osteoarthritis is a common and severe, multifactorial disease with a well-established genetic component. However, little is known about how genetics affect disease progression, and thereby the need for joint placement. Therefore, we aimed to investigate whether the genetic associations of knee and hip osteoarthritis differ between patients treated with joint replacement and patients without joint replacement. Methods We included knee and hip osteoarthritis cases along with healthy controls, altogether counting &gt;700 000 individuals. The cases were divided into two groups based on joint replacement status (surgical vs non-surgical) and included in four genome-wide association meta-analyses: surgical knee osteoarthritis (N = 22 525), non-surgical knee osteoarthritis (N = 38 626), surgical hip osteoarthritis (N = 20 221) and non-surgical hip osteoarthritis (N = 17 847). In addition, we tested for genetic correlation between the osteoarthritis groups and the pain phenotypes intervertebral disc disorder, dorsalgia, fibromyalgia, migraine and joint pain. Results We identified 52 sequence variants associated with knee osteoarthritis (surgical: 17, non-surgical: 3) or hip osteoarthritis (surgical: 34, non-surgical: 1). For the surgical phenotypes, we identified 10 novel variants, including genes involved in autophagy (rs2447606 in ATG7 ) and mechanotransduction (rs202127176 in PIEZO1 ). One variant, rs13107325 in SLC39A8 , associated more strongly with non-surgical knee osteoarthritis than surgical knee osteoarthritis. For all other variants, significance and effect sizes were higher for the surgical phenotypes. In contrast, genetic correlations with pain phenotypes tended to be stronger in the non-surgical groups. Conclusions Our results indicate differences in genetic associations between knee and hip osteoarthritis depending on joint replacement status.